BACKGROUND: In kidney transplantation, the association of cold ischemia time (CIT), anastomosis time (AT), and delayed graft function (DGF) is particularly detrimental in grafts from marginal donors; however, actual cut-off criteria are still debated.

MATERIAL AND METHODS: Data from patients >65 years (n=193) and patients <65 years (n=1054) transplanted between 2000 and 2010 were retrospectively analyzed regarding the age-dependent impact of ischemia times and DGF.

RESULTS: Overall death censored graft survival was inferior for ECD/DCD organs. Graft survival was significantly impaired by DGF in younger and older recipients. The multivariate analysis revealed an age-dependent profile of risk factors for DGF. In younger patients, multiple risk factors were identified while in patients >65 years, only CIT and AT were correlated with DGF. Marginal grafts with a CIT<769 min had a comparable outcome to any SCD organ; extended CIT >770 min worsened ECD/DCD survival significantly. Similarly, AT longer than 26 min was associated with a significantly impaired survival of ECD/DCD grafts. In a Cox regression analysis with penalized splines, this increased risk of graft loss was not linear: CIT beyond 800 min and AT beyond 20 min were cut-off values associated with worse outcomes in marginal organs.

CONCLUSIONS: Thus, risk factors for DGF are age-dependent; keeping ischemia times below these thresholds offers outcome of ECD/DCD organs comparable to SCD organs.

Keywords: cold ischemia, Frail Elderly, Kidney Transplantation, warm ischemia